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Atkins, N.B. (1967). Comments on Severe and Psychotic Regressions in Analysis. J. Amer. Psychoanal. Assn., 15:584-605.

(1967). Journal of the American Psychoanalytic Association, 15:584-605

Comments on Severe and Psychotic Regressions in Analysis

Norman B. Atkins, M.D.


Regression is a necessary part of the psychoanalytic process. Various aspects of the analytic situation facilitate regression. In seriously disturbed patients, the regressive movement will inevitably bring into the transference the grave disturbances they have experienced in their early object and part-object relationships. With these patients the basic capacity for dependence necessary for the therapeutic alliance is impaired. They are in great part unaware of their need for a genuinely dependent relationship and they are limited in their capacity to accept or utilize one. For this reason the therapeutic alliance itself becomes the subject of the analytic work.

An excerpt from the early part of an analysis of a patient whose illness was manifested by a severe regression is presented. Despite the severity of the disturbance it was possible to maintain the usual analytic situation with few parameters and to analyze the regressive experience. The regression was understood to be a reliving of the disturbed mother-child relationship.

One source of the hesitancy about taking into analysis severely disturbed patients is in the difficulties which arise in the intimate analytic situation for analyst as well as patient. The intensity of these patients' affects and their persistent intrusive attempts at projection make it difficult for the analyst to avoid reactivation of his own dormant conflicts.

Yet analysis can offer these patients much that is supportive and integrative—a consistency, a reality-oriented object relationship, and the means for understanding the regressive rearousal of conflicts.

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